BACKGROUND: Burn scars are common in the paediatric population. When involving the face, it diminishes quality of life. Ablative fractional laser (AFL) therapy is becoming the preferred choice for established scars due to its greater potential depth for thermal injury (4 mm), which leads to photothermolysis with subsequent neocollagenesis and collagen fibre realignment and remodelling. Combined with small z-plasties and topical steroids, it has been proven to: flatten and decrease the volume of scars, increase pliability and decrease pruritus and erythema. The purpose of the case series was to determine the clinical significance of a single session of AFL therapy, combined with small z-plasties and topical steroids on facial scars post burn injury. METHODS: Four cases of paediatric facial scarring post burns were selected to undergo a single treatment of AFL therapy, accompanied by small z-plasties and topical steroids. Modified Vancouver Scar Scores (MVSS) pre- and postoperatively at 3 and 6 months were evaluated RESULTS: Improvement of all components of the MVSS was achieved after 6 months, with major improvement in scar pliability and symptomatology. The mean MVSS improved from 14 (range 12-16) preoperatively to 5 and 5.5 respectively at 3 and 6 months postoperatively. Non-parametric analysis with Friedman Two-Way ANOVA by Rank showed a statistical significance between the pre- and postoperative MVSS (p = 0.024) CONCLUSION: AFL should form an integral part of the burn scar armamentarium.

ABSTRACT Prevertebral calcific tendinitis is a benign and infrequent pathology, with an annual incidence of 0.5 cases per 100,000 habitants. We report the case of a 52-year-old woman that presented with a 5-day history of cervicalgia, odynophagia and dysphonia. Otolaryngological examination and radiological images showed occupation of the retropharyngeal space. The patient was admitted to the hospital for intravenous treatment. A cervical MRI was requested, suggesting an acute calcific tendinitis of the longus colli muscles. The authors provide a discussion of the clinical findings, diagnosis and treatment of this condition. We consider it to be an important differential diagnosis of a retropharyngeal space occupation, in order to avoid unnecessary procedures.

RESUMEN La tendinitis calcificante prevertebral es una patología benigna y poco frecuente, con una incidencia anual de 0,5 casos por cada 100.000 habitantes. Se presenta un caso de una paciente de 52 años que consultó por cervicalgia, odinofagia y disfonía de 5 días de evolución. Tras una exploración otorrinolaringológica completa se sospechó ocupación del espacio retrofaríngeo, confirmada con pruebas de imagen. Ante estos hallazgos y con la sospecha de absceso retrofaríngeo, se decidió ingreso hospitalario para tratamiento intravenoso. Por discordancia entre la clínica, la TC y los hallazgos analíticos, se solicitó RM cervical, cuya imagen hizo sospechar una tendinitis aguda calcificante del longísimo del cuello. En este trabajo se ha realizado una revisión de la sintomatología, el diagnóstico y el tratamiento de esta entidad. Consideramos importante sospecharla dentro del diagnóstico diferencial de la ocupación del espacio retrofaríngeo para evitar realizar procedimientos innecesarios.

Paracoccidioides brasiliensis and P. lutzii are fungi that cause paracoccidioidomycosis (PCM), the most prevalent systemic mycosis in South America. For serological diagnosis, although 43-kDa glycoprotein (gp43) is regarded as highly specific for PCM, the occurrence of false negative reactions in sera from patients infected with P. lutzii suggests that preparation with only one antigen is not recommended. Heat shock proteins are feasible alternatives as a second antigen because they are often highly immunogenic. In this study, we evaluated the usefulness of recombinant 60-kDa heat shock protein from P. brasiliensis (rPbHsp60) for the serological diagnosis of PCM. Using western blotting assay, we observed that 77.3% of the sera from PCM patients were positive to rPbHsp60, with 90.9% positivity to recombinant gp43 (rgp43). More importantly, sera from healthy subjects had 27% positivity to rPbHsp60 and none to rgp43. When rPbHsp60 was used in ELISA, we did not observe significant differences between the reactions with sera from PCM patients and healthy subjects, while the difference was clearly evident when the antigen was rgp43. Furthermore, rPbHsp60 was recognized by sera from patients with histoplasmosis, aspergillosis, sporotrichosis or tuberculosis in an ELISA test. These results show that rPbHsp60 is not a good antigen for PCM diagnosis.

BACKGROUND. Burn injuries are common in poverty-stricken countries. The majority of patients with large and complex burns are referred to burn centres. Of the children who qualify for admission, according to burn admission criteria, about half require some kind of surgical procedure to obtain skin cover. These range from massive full-thickness fire burns to skin grafts for small, residual unhealed wounds. Burn anaesthetic procedures are of the most difficult to perform and are known for high complication rates. Reasons include peri-operative sepsis, bleeding, issues around thermoregulation, the hypermetabolic state, nutritional and electrolyte issues, inhalation injuries and the amount of movement during procedures to wash patients, change drapes and access different anatomical sites. The appropriate execution of surgery is therefore of the utmost importance for both minor and major procedures. OBJECTIVE. To review the peri-operative management and standard of surgical care of burnt children. METHODS. This was a retrospective review and analysis of standard peri-operative care of burnt children at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. A total of 558 children were operated on and supervised by the first author. Factors that could adversely affect surgical and anaesthetic outcomes were identified. RESULTS. There were 257 males and 301 females in this study, with an average age of 50.1 months and average weight of 19.5 kg. The total body surface area involved was 1 - 80%, with an average of 23.5%. Inhalational injury was present in 11.3%, pneumonia in 13.1%, wound sepsis in 20.8%, and septicaemia in 9.7%, and organ dysfunction in more than one organ was seen in 6.1%. The average theatre temperature during surgery was 30.0°C. Core temperatures recorded at the start, halfway through and at completion of surgery were 36.9°C, 36.8°C and 36.5°C, respectively. The average preoperative and postoperative haemoglobin levels were 11.28 g/dL and 9.64 g/dL, respectively. Blood loss was reduced by the use of clysis from 1.5 mL/kg/% burn to 1.4 mL/kg/% burn. Adverse intraoperative events were seen in 17.6% of children. CONCLUSION. Burn surgery is a high-risk procedure and comorbidities are common. Anaesthesia and surgery must be well planned and executed with special reference to temperature control, rapid blood loss, preceding respiratory illnesses and measures to reduce blood loss.

BACKGROUND. The cost of Abbreviated Injury Scale (AIS) coding has limited its utility in areas of the world with the highest incidence of trauma. We hypothesised that emerging mobile health (m-health) technology could offer a cost-effective alternative to the current gold-standard AIS mechanism in a high-volume trauma centre in South Africa. METHODS. A prospectively collected sample of consecutive patients admitted following a traumatic injury that required an operation during a 1-month period was selected for the study. AISs and Injury Severity Scores (ISSs) were generated by clinician-entered data using an m-health application (ISS eTHR) as well as by a team of AIS coders at Vancouver General Hospital, Canada (ISS VGH). Rater agreements for ISSs were analysed using Bland-Altman plots with 95% limits of agreement (LoA) and kappa statistics of the ISSs grouped into ordinal categories. Reliability was analysed using a two-way mixed-model intraclass correlation coefficient (ICC). Calibration and discrimination of univariate logistic regression models built to predict in-hospital complications using ISSs coded by the two methods were also compared. RESULTS. Fifty-seven patients were managed operatively during the study period. The mean age of the cohort was 27.2 years (range 14 - 62), and 96.3% were male. The mechanism of injury was penetrating in 93.4% of cases, of which 52.8% were gunshot injuries. The LoA fell within -8.6 - 9.4. The mean ISS difference was 0.4 (95% CI -0.8 - 1.6). The kappa statistic was 0.53. The ICC of the individual ISS was 0.88 (95% CI 0.81 - 0.93) and the categorical ISS was 0.81 (95% CI 0.68 - 0.87). Model performance to predict in-hospital complications using either the ISS eTHR or the ISS VGH was equivalent. CONCLUSIONS. ISSs calculated by the eTHR and gold-standard coding were comparable. Emerging m-health technology provides a cost-effective alternative for injury severity scoring.

Optical coherence tomography (OCT) is a promising medical imaging technique that uses light to capture real-time cross-sectional images from biological tissues in micrometer resolution. Commercially available optical coherence tomography systems are employed in diverse applications, including art conservation and diagnostic medicine, notably in cardiology and ophthalmology. Application of this technology in the brain may enable distinction between white matter and gray matter, and obtainment of detailed images from within the encephalon. We present, herein, the in vivo implementation of OCT imaging in the rat brain striatum. For this, two male 60-day-old rats (Rattus norvegicus, Albinus variation, Wistar) were stereotactically implanted with guide cannulas into the striatum to guide a 2.7-French diameter high-definition OCT imaging catheter (Dragonfly™, St. Jude Medical, USA). Obtained images were compared with corresponding histologically stained sections to collect imaging samples. A brief analysis of OCT technology and its current applications is also reported, as well as intra-cerebral OCT feasibility on brain mapping during neurosurgical procedures.

Mejorar las grandes ciudades requiere la construcción de importantes infraestructuras subterráneas para asegurar la movilidad y la optimización del uso urbano del suelo. La monitorización es uno de los grandes retos del mega-proyecto "Madrid Río (2003-2008)". El soterramiento de la autovía de circunvalación M-30, que discurre junto al río Manzanares, requirió la ejecución de dos túneles gemelos. Este artículo presenta los resultados del estudio de las subsidencias que dichas obras indujeron en el terreno mediante el uso de la técnica DInSAR (Differential Interferometry Synthetic Aperture Radar), aplicada a las imágenes radar ENVISAT tomadas entre agosto de 2003 y abril de 2008, utilizando la técnica PSI (Persistent Scatterers Interferometry). Los resultados obtenidos se compararon con las medidas de los extensómetros tradicionales instalados en la zona, llegando a la conclusión de que esta técnica produce unos buenos resultados y es complementaria de cualquier otra tradicional.

Big cities improvement usually requires the construction of large underground infrastructures, in order to ensure proper communication and optimize urban use. Monitoring ground subsidences is therefore one of the main challenges in changing urban environments. "Madrid Rio" project (2003-2008) is an effort to reclaim the riverfront land and improve the busy M-30 beltway that involved the construction of 7.93 km of tunnels underneath the southern center of Madrid City. This paper presents a remote-sensing approach to monitor ground subsidences induced by tunneling excavation. Persistent Scatterers Interferometry technique (PSI) was used to estimate subsidence and displacement time series from Synthetic Aperture Radar images, acquired between August 2003 and April 2008 from ENVISAT. Remote sensed results were compared to traditional extensometric measures, fitting adequately for selected sectors. Spatial analysis of displacements allowed evaluating impacts of tunneling on surrounding buildings and facilities, highlighting critical areas. The availability of a spatial distribution of displacements in a time series allowed analyzing longitudinal, cross-sectional and temporal dynamics. The main limitations found were the heterogeneous spatial distribution of Persistent Scatterers, the absence of measurement points in work areas, the threshold for velocity detection and low temporal resolution of ENVISAT images. Nevertheless, these limitations of DInSAR for monitoring infrastructures are overcome by actual satellites, being a complementary technique with an exceptional added value and temporal analysis capability.

Brucelose bovina causada por Brucella abortus é uma importante doença zoonótica, caracterizada pela ocorrência de aborto durante o último trimestre da gestação, o que resulta em diminuição da fertilidade da produção de leite em vacas. A identificação de genes associados à resistência natural contra brucelose tem sido investigada com o objetivo de selecionar animais resistentes à doença. Em bovinos, é controversa a resistência natural contra B. abortus associada ao polimorfismo da região 3' UTR do gene Slc11A1 (Nramp1). Polimorfismos localizados na sequência codificadora de Slc11A1 têm sido identificados em bovinos, contudo a influência sobre a resistência natural contra brucelose não é conhecida. No presente estudo, três novos polimorfismos do gene Slc11A1 foram genotipados por análise conformacional de fita simples em vacas experimentalmente ou naturalmente infectadas por B. Abortus, e foram avaliadas a frequência de cada genótipo e sua associação com o fenótipo de resistência ou susceptibilidade à brucelose bovina. Os resultados deste estudo demonstram que alguns genótipos foram mais frequentes em animais considerados fenotipicamente susceptiveis à brucelose.

The objective of this study is to retrospectively report the results of interventions for controlling a vancomycin-resistant enterococcus (VRE) outbreak in a tertiary-care pediatric intensive care unit (PICU) of a University Hospital. After identification of the outbreak, interventions were made at the following levels: patient care, microbiological surveillance, and medical and nursing staff training. Data were collected from computer-based databases and from the electronic prescription system. Vancomycin use progressively increased after March 2008, peaking in August 2009. Five cases of VRE infection were identified, with 3 deaths. After the interventions, we noted a significant reduction in vancomycin prescription and use (75% reduction), and the last case of VRE infection was identified 4 months later. The survivors remained colonized until hospital discharge. After interventions there was a transient increase in PICU length-of-stay and mortality. Since then, the use of vancomycin has remained relatively constant and strict, no other cases of VRE infection or colonization have been identified and length-of-stay and mortality returned to baseline. In conclusion, we showed that a bundle intervention aiming at a strict control of vancomycin use and full compliance with the Hospital Infection Control Practices Advisory Committee guidelines, along with contact precautions and hand-hygiene promotion, can be effective in reducing vancomycin use and the emergence and spread of vancomycin-resistant bacteria in a tertiary-care PICU.

Heliconia curtispatha Petersen (Zingiberales) comúnmente conocida como platanillo, es usada en la medicina tradicional colombiana por su acción antiedematizante, antihemorrágica y neutralizante del veneno de Bothrops asper (mapaná) responsable del 95% de las mordeduras de serpientes en el país. Lo anterior destaca su utilidad y potencial función, como coadyuvante en el tratamiento del accidente ofídico. La propagación por cultivos in vitro, se convierte en una herramienta valiosa e interesante para su masificación, debido al difícil acceso al material vegetal en su ambiente natural y la carencia de estudios previos en multiplicación in vitro de esta especie. En el presente trabajo se obtienen plántulas a partir de semillas y se evalúa su propagación en medios de cultivo Murashige & Skoog, semisólidos y líquidos suplementados con reguladores de crecimiento tipo citoquinina. Experimentalmente, se favorece la propagación de la Heliconia (2 brotes semana-1) cuando se utiliza medio Murashige & Skoog líquido sin adición de reguladores de crecimiento o al emplear Murashige & Skoog semisólido adicionándole 2 mg.L-1 6-Bencilaminopurina 0.93 brotes.semana-1. Este es el primer reporte de propagación in vitro de H. curtispatha y el primer paso para el estudio de metabolitos secundarios con potencial antiofídico que pueden producirse bajo tales condiciones.

Heliconia curtispatha Petersen (Zingiberales) commonly known as platanillo, is used in colombian traditional medicine by its anti-edema, antihaemorrhagic and neutralising action of Bothrops asper (mapaná, X) venom, responsible for 95% of snakebites in the country. The previous, emphasizes its utility and potential function as helper in the treatment of the ophidian accident. The in vitro propagation techniques becomes an interesting tool for plant and metabolites production, because of the hazardous accessibility to plants in their natural environment and the deficiency of previous studies on in vitro multiplication of the specie. In the present work, plantlets are obtained from seeds and its in vitro p ropagation is evaluated in Murashige & Skoog semi-solid and liquid medium without or in combination with citokinines-like. Experimentally, it promotes the propagation of Heliconia (2 weeks outbreaks -1) when using Murashige & Skoog liquid medium without added growth regulators or by using Murashige & Skoog semisolid adding 2 mg.L-1 6-benzylaminopurine 0.93 week outbreaks -1. This is the first report of in vitro propagation of H. curtispatha and the first step for the study of secondary metabolites with potential venom that can occur under such conditions.